Knowledge and attitudes of German and Swiss community pharmacists towards biologicals and biosimilars - a prospective survey before and after the COVID-19 pandemic

Abstract

Background: Knowledge, attitudes and substitution laws of biosimilars are not consistent across countries. Biosimilar acceptance among patients and healthcare professionals may be suffering from gaps in knowledge and understanding about biosimilars and their regulatory approval process. Pharmacists' roles and responsibilities changed considerably during the COVID-19 pandemic. Thus, they might have gained new skills and self-confidence in counseling and substitution of biosimilars.

Aims: To examine and compare the knowledge, perceptions and information needs of German and Swiss pharmacists regarding original biologicals and biosimilars in 2020 and 2022.

Methods: We conducted an online survey among Swiss and German community pharmacies in February 2020 (before) and August 2022 (after the COVID-19 pandemic). Descriptive statistics were calculated and the Chi-Square test was used for comparisons among categorical variables.

Results: A total of 764 pharmacists took part in the survey (390 in 2020 and 374 in 2022) with comparable demographics. The frequency of dispensing biologicals remained similar between German and Swiss pharmacists in 2020 and 2022, but the Swiss dispensation of biosimilars increased significantly in 2022 compared to 2020. Concerning the understanding of the term biosimilars, knowledge remained moderate in both countries in both years. Participants were equally familiar with the term and most felt sufficiently informed. In both countries, substitution with a biosimilar showed the least confidence of all attitudes. A third of the participants indicated correct substitution rules in their country. In both years, around 85% of the participants were highly interested in additional training on this topic.

Discussion/conclusion: The results indicate that similarities and differences between Germany and Switzerland regarding knowledge and attitudes towards biologicals and biosimilars remained unchanged before and after the COVID-19 pandemic. An influence of the pandemic is unlikely. There is still a clear lack of knowledge among community pharmacists on biosimilars, especially regarding the substitution rules. Due to a rising market with many benefits but also big challenges to overcome, the topic of biosimilars should receive more attention in the future. This requires additional training for pharmacists.

Keywords: Attitudes; Biological; Biosimilars; Community pharmacy; Covid-19 pandemic; Knowledge; Survey.

Fig. 1

Dispensation of biologicals (panel A) and biosimilars (panel B) by community pharmacists in 2020 and 2022 in Switzerland (dotted bars) and Germany (solid bars) according to the frequencies ≥ 2 times a week and ≤ 1 time a week; statistical significance is marked with an asterisk

Fig. 2

Agreement (in %) to 6 attitudes regarding biosimilars of Swiss (dotted bars) and German (solid bars) pharmacists regarding biosimilars in 2020 (left panel) and 2022 (right panel); statistical significance is marked with an asterisk

Fig. 3

Comparison of answers on whether substitution should be permitted on treatment start or during treatment course by the Swiss (dotted bars) and German (solid bars) community pharmacists in 2020 (left panel) and 2022 (right panel); statistical significance is marked with an asterisk